<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>预约申请</title>
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<script type="text/javascript" src="index.js"></script>
</head>
<body>

	<div class="content" style="width:1000px; margin:0 auto 50px;">
		<div class="panel panel-primary">
			<div class="panel-heading">
				<h3 class="panel-title">预约信息</h3>
			</div>
			<div class="panel-body">
			
	<form class="form-horizontal" id="reserveForm">
		<table class="table table-bordered"style="vertical-align: middle !important; text-align: left;">
			<tr>
				<td style="background-color: #eee;">公司名称</td>
				<td ><input id="company" type="text" class="form-control" readonly="readonly" /></td>
				<td style="background-color: #eee;">公司地址</td>
				<td colspan="3"><input type="text" class="form-control" id="contactAddr" readonly="readonly"></td>
			</tr>
			<tr>
				<td style="background-color: #eee;">申请人：</td>
				<td>
					<input name="USERNAME"  id="userName" type="text" class="form-control" readonly="readonly" />
				</td>
				<td style="background-color: #eee;">联系人<span style="color: red;">*</span>：
				</td>
				<td>
					<input name="CONTACTS"  id="contacts" type="text" class="form-control" placeholder="请输入联系人" />
				</td>
				<td style="background-color: #eee;">联系电话<span style="color: red;">*</span>：
				</td>
				<td>
					<input name="PHONENUM"  id="phoneNum" type="text" class="form-control" placeholder="请输入联系电话" />
				</td>
			</tr>
			<tr>
				<td style="background-color: #eee;">受理机构<span style="color: red;">*</span>：
				</td>
				<td>
				<input type="text" class="form-control" name="ORGCODE" id="orgSelect" >
				<input type="hidden" id="orgcode" />
				</td>
				<td style="background-color: #eee;">申请业务<span style="color: red;">*</span>：
				</td>
				<td colspan="3">
					<select class="form-control" name="ITEMID" id="bespeakItems" multiple="multiple" placeholder="请选择预约业务" ></select>
				</td>		
			</tr>
			<tr>
				<td style="background-color: #eee;">申请理由<span style="color: red;">*</span>：
				</td>
				<td colspan="5"><textarea class="form-control" rows="5" id="liyou" name="LIYOU" placeholder="请输入申请理由"></textarea>
				</td>
			</tr>
			<tr>
				<td style="background-color: #eee;">预约日期<span style="color: red;">*</span>：
				</td>
				<td >
					<input class="form-control" type="date" id ="RECORDDATE" placeholder="请选择预约日期" name="RECORDDATE" />
				</td>
				<td style="background-color: #eee;">预约时间段<span style="color: red;">*</span>：
				</td>
				<td colspan="3">					
					 <select class="form-control" name="RECORDPERIOD" id="recordperiod" placeholder="请选择预约时间段" ></select> 
				</td>
			</tr>
			
		</table>
	</form>
			</div>
		</div>
		
		<div style="text-align: center;">
			<button type="button" class="btn btn-primary" id="save">提交</button>
			<button type="button" class="btn btn-default" id="nosave">取消</button>
		</div>

	</div>

</body>
</html>